Title: Novel treatment of sleep apnea by upper airway and respiratory muscle training. In recent years, we and others have discovered that spinal cord injury/disease (SCI/D) is associated with significant increase in the sleep-disordered breathing (SDB) prevalence. Nearly 80% of patients with SCI/D including Veterans suffer from SDB after six months of injury (majority of them 70-80% are obstructive apneas and hypopneas-OSA). However, most patients SCI/D do not tolerate standard SDB treatment (continuous positive airway pressure-CPAP) leading to lack of compliance. Therefore, identifying other therapies is important for this common condition that is linked to poor outcome in the general population (heart disease, stroke, hypertension and poor cognition). It has been reported in sleep apnea able-bodied patients that oropharyngeal muscle exercises for 3 months using speech pathology techniques improve the severity of SDB. Furthermore, previous studies showed respiratory muscle training (RMT) is effective for increasing respiratory muscle strength in people with cervical SCI. However, the effect of combined oropharyngeal and RMT on OSA in patients with SCI is unknown. The purpose of this application is to identify new therapeutic interventions for OSA treatment in Veterans with SCI/D. This application proposes for a pilot study to randomizing 30 Veterans with SCI/D and OSA to receive 3 months of daily (30 minutes) treatment with a validated set of oropharyngeal and RMT (intervention arm) versus sham therapy (control arm). There will be three specific aims to address the following hypotheses:
Specific Aim (1): To test recruitment rate and feasibility of a pilot intervention that includes combined oropharyngeal and RMT versus sham treatment in individuals with SCI/D.
Specific Aim (2): To test the acceptability and usability of combined oropharyngeal and RMT in individuals with SCI/D.
Specific Aim (3): To determine the effect size estimates for clinical endpoints and their associated variability at the end of treatment to calculate an appropriate sample size for an adequately powered clinical trial.

Public Health Relevance

It is estimated that spinal cord injury (SCI) affects approximately 12,000 new individuals every year in the United States, with the majority being cervical and/or upper thoracic injuries. Despite the high prevalence of sleep disordered breathing (SDB) in chronic SCI population, only a minority of patients are treated and are adherent to standard therapy (CPAP). This proposal addresses a new therapeutic intervention for sleep apnea in SCI. We hypothesize that combined oropharyngeal and respiratory muscle exercises improve respiratory symptoms and alleviate SDB in patients with chronic SCI. We will perform a pilot randomized, sham-controlled study to examine the impact of combined daily exercises (~30 min) for 1 and 3 month durations among Veterans with SCI. We believe this novel approach to treating SDB will yield significant new knowledge that improves the health and quality of life of these patients.

National Institute of Health (NIH)
Veterans Affairs (VA)
Veterans Administration (I21)
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Rehabilitation Research and Development SPiRE Program (RRDS)
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John D Dingell VA Medical Center
United States
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